Action Points

Note that this observational study in a U.K. population suggested that even small amounts of exercise are associated with mortality benefits.

Be aware that chronic health conditions limiting the ability to exercise may account for some of the observed association.

Some exercise is better than none, a U.K. observational study suggested, as even those who exercised irregularly or insufficiently still had a drop in mortality rates in the long run.

Compared with inactive people in the study, individuals who exercised were at lower risk for death (over an average 8.8 years of follow-up), no matter how much physical activity they performed per week, categorized as follows:

Insufficient activity: less than 150 minutes/week in moderate-intensity or less than 75 minutes/week in vigorous activity (HR 0.66, 95% CI 0.62-0.72)

"Weekend warrior" pattern: more than 150 minutes/week in moderate-intensity or more than 75 minutes/week in vigorous activity in one or two sessions (HR 0.70, 95% CI 0.60-0.82)

Regular activity: more than 150 minutes/week in moderate-intensity or more than 75 minutes/week in vigorous activity over three or more sessions (HR 0.65, 95% CI 0.58-0.73)

"The present study suggests that less frequent bouts of activity, which might be more easily fit into a busy lifestyle, offer considerable health benefits, even in the obese and those with major risk factors," Gary O'Donovan, PhD, of the National Centre for Sport and Exercise Medicine-East Midlands at Loughborough University, concluded in a paper published online in JAMA Internal Medicine.

"Although the recommended frequency is not specified, inactive adults are suggested to first increase duration and frequency and then increase intensity to achieve the recommended doses of activity while reducing the risk for musculoskeletal injury."

Writing in an accompanying editorial, Hannah Arem, PhD, and Loretta DiPietro, PhD, both of George Washington University in Washington, D.C., said: "In response to the question of whether activity can wait for the weekend, the short answer is perhaps, because O'Donovan et al show a lower mortality risk with a compressed activity pattern."

Arem and DiPietro suggested that individuals find an activity pattern that works for them in terms of their health, schedule, and access to exercise.

"Despite the known benefits of physical activity, an estimated 24% of U.S. adults engaged in no leisure time physical activity in 2013," the editorial noted. "This statistic draws attention to the need for implementation research to create multiple-sector (e.g., transportation, education, healthcare, media, urban planning, worksite) opportunities for increasing physical activity in the adult population."

For the study, O'Donovan and colleagues retrospectively pooled responses to the Health Survey for England and the Scottish Health Survey from 1994 to 2012, with participants sharing exercise routines with trained interviewers. The data were linked to death records from the British National Health Service Central Registry.

In total, 63,591 respondents over age 40 reported their levels of exercise (45.9% men; mean age of 58.6).

The investigators acknowledged that study limitations included the fact that more than 90% of the participants were white, limiting the generalizability of the data to other racial groups. They also assessed physical activity at baseline without accounting for changes throughout time.

"We cannot discount the possibility of reverse causation in which participants with underlying disease are less likely to be physically active," the team added. "However, we excluded deaths in the first 24 months of follow-up; adjusted for long-standing illness, cardiovascular disease, and cancer at baseline; and performed sensitivity analyses to address the issue of reverse causation."

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